Management of psychogenic nonepileptic seizures (PNES): a multidisciplinary approach

Sara Gasparini, Ettore Beghi, Edoardo Ferlazzo, Massimiliano Beghi, Vincenzo Belcastro, Klaus P Biermann, Gabriella Bottini, Giuseppe Capovilla, Rosa A Cervellione, Vittoria Cianci, Giangennaro Coppola, Cesare M Cornaggia, Pasquale De Fazio, Salvatore De Masi, Giovambattista De Sarro, Maurizio Elia, Giuseppe Erba, Lucia Fusco, Antonio Gambardella, Valentina GentileAnna T Giallonardo, Renzo Guerrini, Francesca Ingravallo, Alfonso Iudice, Angelo Labate, Ersilia Lucenteforte, Adriana Magaudda, Laura Mumoli, Costanza Papagno, Giovanni B Pesce, Eugenio Pucci, Pietrantonio Ricci, Antonino Romeo, Rui Quintas, Chiara Sueri, Giovanna Vitaliti, Riccardo Zoia, Umberto Aguglia

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The International League Against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic nonepileptic seizures (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized, and management might differ according to the age groups.

OBJECTIVE: To reach an expert and stakeholder consensus on PNES management.

METHODS: A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed. The board chose five main topics regarding PNES: "diagnosis"; "ethical issues"; "psychiatric comorbidities"; "psychological treatment"; "pharmacological treatment". After a systematic review of the literature, the board met in a Consensus Conference in Catanzaro (Italy). Further consultations using the model of Delphi panel were held.

RESULTS: The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizures' induction was considered ethical, preferring the least invasive techniques. The board recommended: to carefully look for mood disturbances, personality disorders and psychic trauma in persons with PNES; to consider cognitive-behavioural therapy as first line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression.

CONCLUSIONS: PNES management should be multidisciplinary. High-quality, long-term studies are needed to standardize PNES management. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalEuropean Journal of Neurology
DOIs
Publication statusE-pub ahead of print - Oct 9 2018

Fingerprint

Seizures
Psychiatry
Epilepsy
Consensus
Pharmacology
Psychology
Patient Advocacy
Bioethics
Forensic Medicine
Personality Disorders
Cognitive Therapy
Therapeutics
Ethics
Italy
Comorbidity
Referral and Consultation
Anxiety
Age Groups
Depression
Wounds and Injuries

Cite this

Management of psychogenic nonepileptic seizures (PNES) : a multidisciplinary approach. / Gasparini, Sara; Beghi, Ettore; Ferlazzo, Edoardo; Beghi, Massimiliano; Belcastro, Vincenzo; Biermann, Klaus P; Bottini, Gabriella; Capovilla, Giuseppe; Cervellione, Rosa A; Cianci, Vittoria; Coppola, Giangennaro; Cornaggia, Cesare M; De Fazio, Pasquale; De Masi, Salvatore; De Sarro, Giovambattista; Elia, Maurizio; Erba, Giuseppe; Fusco, Lucia; Gambardella, Antonio; Gentile, Valentina; Giallonardo, Anna T; Guerrini, Renzo; Ingravallo, Francesca; Iudice, Alfonso; Labate, Angelo; Lucenteforte, Ersilia; Magaudda, Adriana; Mumoli, Laura; Papagno, Costanza; Pesce, Giovanni B; Pucci, Eugenio; Ricci, Pietrantonio; Romeo, Antonino; Quintas, Rui; Sueri, Chiara; Vitaliti, Giovanna; Zoia, Riccardo; Aguglia, Umberto.

In: European Journal of Neurology, 09.10.2018.

Research output: Contribution to journalArticle

Gasparini, S, Beghi, E, Ferlazzo, E, Beghi, M, Belcastro, V, Biermann, KP, Bottini, G, Capovilla, G, Cervellione, RA, Cianci, V, Coppola, G, Cornaggia, CM, De Fazio, P, De Masi, S, De Sarro, G, Elia, M, Erba, G, Fusco, L, Gambardella, A, Gentile, V, Giallonardo, AT, Guerrini, R, Ingravallo, F, Iudice, A, Labate, A, Lucenteforte, E, Magaudda, A, Mumoli, L, Papagno, C, Pesce, GB, Pucci, E, Ricci, P, Romeo, A, Quintas, R, Sueri, C, Vitaliti, G, Zoia, R & Aguglia, U 2018, 'Management of psychogenic nonepileptic seizures (PNES): a multidisciplinary approach', European Journal of Neurology. https://doi.org/10.1111/ene.13818
Gasparini, Sara ; Beghi, Ettore ; Ferlazzo, Edoardo ; Beghi, Massimiliano ; Belcastro, Vincenzo ; Biermann, Klaus P ; Bottini, Gabriella ; Capovilla, Giuseppe ; Cervellione, Rosa A ; Cianci, Vittoria ; Coppola, Giangennaro ; Cornaggia, Cesare M ; De Fazio, Pasquale ; De Masi, Salvatore ; De Sarro, Giovambattista ; Elia, Maurizio ; Erba, Giuseppe ; Fusco, Lucia ; Gambardella, Antonio ; Gentile, Valentina ; Giallonardo, Anna T ; Guerrini, Renzo ; Ingravallo, Francesca ; Iudice, Alfonso ; Labate, Angelo ; Lucenteforte, Ersilia ; Magaudda, Adriana ; Mumoli, Laura ; Papagno, Costanza ; Pesce, Giovanni B ; Pucci, Eugenio ; Ricci, Pietrantonio ; Romeo, Antonino ; Quintas, Rui ; Sueri, Chiara ; Vitaliti, Giovanna ; Zoia, Riccardo ; Aguglia, Umberto. / Management of psychogenic nonepileptic seizures (PNES) : a multidisciplinary approach. In: European Journal of Neurology. 2018.
@article{c1aa4d003e0a42c082538b87e8c8d376,
title = "Management of psychogenic nonepileptic seizures (PNES): a multidisciplinary approach",
abstract = "BACKGROUND: The International League Against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic nonepileptic seizures (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized, and management might differ according to the age groups.OBJECTIVE: To reach an expert and stakeholder consensus on PNES management.METHODS: A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed. The board chose five main topics regarding PNES: {"}diagnosis{"}; {"}ethical issues{"}; {"}psychiatric comorbidities{"}; {"}psychological treatment{"}; {"}pharmacological treatment{"}. After a systematic review of the literature, the board met in a Consensus Conference in Catanzaro (Italy). Further consultations using the model of Delphi panel were held.RESULTS: The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizures' induction was considered ethical, preferring the least invasive techniques. The board recommended: to carefully look for mood disturbances, personality disorders and psychic trauma in persons with PNES; to consider cognitive-behavioural therapy as first line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression.CONCLUSIONS: PNES management should be multidisciplinary. High-quality, long-term studies are needed to standardize PNES management. This article is protected by copyright. All rights reserved.",
author = "Sara Gasparini and Ettore Beghi and Edoardo Ferlazzo and Massimiliano Beghi and Vincenzo Belcastro and Biermann, {Klaus P} and Gabriella Bottini and Giuseppe Capovilla and Cervellione, {Rosa A} and Vittoria Cianci and Giangennaro Coppola and Cornaggia, {Cesare M} and {De Fazio}, Pasquale and {De Masi}, Salvatore and {De Sarro}, Giovambattista and Maurizio Elia and Giuseppe Erba and Lucia Fusco and Antonio Gambardella and Valentina Gentile and Giallonardo, {Anna T} and Renzo Guerrini and Francesca Ingravallo and Alfonso Iudice and Angelo Labate and Ersilia Lucenteforte and Adriana Magaudda and Laura Mumoli and Costanza Papagno and Pesce, {Giovanni B} and Eugenio Pucci and Pietrantonio Ricci and Antonino Romeo and Rui Quintas and Chiara Sueri and Giovanna Vitaliti and Riccardo Zoia and Umberto Aguglia",
note = "This article is protected by copyright. All rights reserved.",
year = "2018",
month = "10",
day = "9",
doi = "10.1111/ene.13818",
language = "English",
journal = "European Journal of Neurology",
issn = "1351-5101",
publisher = "Wiley-Blackwell Publishing Ltd",

}

TY - JOUR

T1 - Management of psychogenic nonepileptic seizures (PNES)

T2 - a multidisciplinary approach

AU - Gasparini, Sara

AU - Beghi, Ettore

AU - Ferlazzo, Edoardo

AU - Beghi, Massimiliano

AU - Belcastro, Vincenzo

AU - Biermann, Klaus P

AU - Bottini, Gabriella

AU - Capovilla, Giuseppe

AU - Cervellione, Rosa A

AU - Cianci, Vittoria

AU - Coppola, Giangennaro

AU - Cornaggia, Cesare M

AU - De Fazio, Pasquale

AU - De Masi, Salvatore

AU - De Sarro, Giovambattista

AU - Elia, Maurizio

AU - Erba, Giuseppe

AU - Fusco, Lucia

AU - Gambardella, Antonio

AU - Gentile, Valentina

AU - Giallonardo, Anna T

AU - Guerrini, Renzo

AU - Ingravallo, Francesca

AU - Iudice, Alfonso

AU - Labate, Angelo

AU - Lucenteforte, Ersilia

AU - Magaudda, Adriana

AU - Mumoli, Laura

AU - Papagno, Costanza

AU - Pesce, Giovanni B

AU - Pucci, Eugenio

AU - Ricci, Pietrantonio

AU - Romeo, Antonino

AU - Quintas, Rui

AU - Sueri, Chiara

AU - Vitaliti, Giovanna

AU - Zoia, Riccardo

AU - Aguglia, Umberto

N1 - This article is protected by copyright. All rights reserved.

PY - 2018/10/9

Y1 - 2018/10/9

N2 - BACKGROUND: The International League Against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic nonepileptic seizures (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized, and management might differ according to the age groups.OBJECTIVE: To reach an expert and stakeholder consensus on PNES management.METHODS: A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed. The board chose five main topics regarding PNES: "diagnosis"; "ethical issues"; "psychiatric comorbidities"; "psychological treatment"; "pharmacological treatment". After a systematic review of the literature, the board met in a Consensus Conference in Catanzaro (Italy). Further consultations using the model of Delphi panel were held.RESULTS: The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizures' induction was considered ethical, preferring the least invasive techniques. The board recommended: to carefully look for mood disturbances, personality disorders and psychic trauma in persons with PNES; to consider cognitive-behavioural therapy as first line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression.CONCLUSIONS: PNES management should be multidisciplinary. High-quality, long-term studies are needed to standardize PNES management. This article is protected by copyright. All rights reserved.

AB - BACKGROUND: The International League Against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic nonepileptic seizures (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized, and management might differ according to the age groups.OBJECTIVE: To reach an expert and stakeholder consensus on PNES management.METHODS: A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed. The board chose five main topics regarding PNES: "diagnosis"; "ethical issues"; "psychiatric comorbidities"; "psychological treatment"; "pharmacological treatment". After a systematic review of the literature, the board met in a Consensus Conference in Catanzaro (Italy). Further consultations using the model of Delphi panel were held.RESULTS: The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizures' induction was considered ethical, preferring the least invasive techniques. The board recommended: to carefully look for mood disturbances, personality disorders and psychic trauma in persons with PNES; to consider cognitive-behavioural therapy as first line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression.CONCLUSIONS: PNES management should be multidisciplinary. High-quality, long-term studies are needed to standardize PNES management. This article is protected by copyright. All rights reserved.

U2 - 10.1111/ene.13818

DO - 10.1111/ene.13818

M3 - Article

C2 - 30300463

JO - European Journal of Neurology

JF - European Journal of Neurology

SN - 1351-5101

ER -